Provider First Line Business Practice Location Address:
647 HUMBOLDT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89835-0336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-752-3556
Provider Business Practice Location Address Fax Number:
775-752-3392
Provider Enumeration Date:
08/10/2006